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The emergence of a second primary cancer is usually one of the leading causes of therapeutic failure in patients with known malignancies. Detection of a second primary cancer may reduce the corresponding morbidity and mortality, especially in patients without the symptoms that are illustrative of a second primary malignancy. Here, we report a rare coincidence of an asymptomatically synchronous esophageal cancer incidentally detected by F-18 fluorodeoxyglucose positron emission tomography/computed tomography in a 65-year-old prostate cancer patient. The treatment strategy was accordingly changed to esophagectomy with colon interposition and jejunostomy after neoadjuvant chemotherapy and radiotherapy.

Kidney impairment is noted in primary aldosteronism (PA), and probably initiated by glomerular hyperfiltration.A prospectively defined survey was conducted on 602 patients who were suspected of PA in the multiple-center Taiwan Primary Aldosteronism Investigation (TAIPAI) database. Estimated glomerular filtration rate (eGFR) was calculated and followed up at 1 yr after treatment.The diagnosis of PA was confirmed in 330 patients. Among them 17% of these patients had kidney impairment (eGFR60 ml/min/1.73 m²). Patients with PA had a higher prevalence of estimated hyperfiltration than those with essential hypertension (EH) (14.5% vs. 7.0%, p=0.005). The eGFR independently predicted PA (OR, 1.017) in the propensity-adjusted multivariate logistic model. In PA, plasma renin activity and lower serum potassium (p=0.018) was correlated with kidney impairment (p=0.001), while this relationship was not significant in patients with EH. Either unilateral adrenalectomy or treatment of spironolactone for PA patients caused a decrease of eGFR (p0.001). Pre-operative hypokalemia (p=0.013) and the long latency of hypertension (p=0.016) could enhance the significant decrease of eGFR after adrenalectomy.Patients with aldosteronism had relative estimated hyperfiltration than patients with EH. Calculation of eGFR may increase the specificity in identifying patients with PA. Our findings demonstrate the correlation of serum potassium and renin with estimated hyperfiltration in PA and their relationship to kidney damage. These results provide a high priority for future renal protective strategies and methods for the early diagnosis and prompt treatment of PA.

Angioma serpiginosum is an uncommon, acquired vascular nevoid disorder with capillary dilation and proliferation in the papillary dermis. The eruptions are asymptomatic and characterized by grouped, erythematous to violaceous, serpiginous and punctate macules. The condition usually appears in females during adolescence on unilateral lower extremities and the buttocks. We report a rare case with a late onset and atypical distribution of lesions in a 48-year-old female patient who had groups of punctate lesions on her left foot for four to five years. Histopathological examination showed hyperkeratosis and multiple dilated and proliferated capillaries in the papillary dermis. Inflammation and extravasation of red blood cells were not found. According to the clinical and pathological findings, we established a diagnosis of angioma serpiginosum. She was treated with a pulsed dye laser, and the angiomatous lesions subsequently improved.

Technetium-99m labeled human serum albumin (Tc-99m HSA) is an important radiopharmaceutical for clinical applications, such as cardiac function tests or protein-losing gastroenteropathy assessment. However, because of transfusion-induced infectious diseases, the safety of serum products is a serious concern. In this context, serum products acquired from patients themselves are the most ideal tracer. However, the development of rapid separation and easy clinical labeling methods is not yet well established. Under such situation, products from the same ethnic group or country are now recommended by the World Health Organization as an alternative preparation. This article describes the on-site preparation of Tc-99m HSA from locally supplied serum products. Different formulations were prepared and the labeling efficiency and stability were examined. Radio-labeling efficiencies were more than 90% in all preparation protocols, except for one that omitted the stannous solution. The most cost-effective protocol contained HSA 0.1 mg, treated with stannous fluoride 0.2 mg, and mixed with Tc-99m pertechnetate 30 mCi. A biodistribution study was performed in rats using a gamma camera immediately after intravenous administration of radiolabeled HSA. Tissue/organ uptake was obtained by measuring the radioactivity in organs after sacrificing the rats at timed intervals. The biologic half-life was about 32 min, determined from sequential venous blood collections. These data indicate that our preparation of Tc-99m HSA is useful and potentially applicable clinically. In addition, this on-site preparation provides the possibility of labeling a patient's own serum for subsequent clinical application.

Potassium supplements have been recommended to hasten recovery and prevent cardiopulmonary complications in patients with thyrotoxic periodic paralysis (TPP). However, this recommendation has not yet been proven efficacious. Thirty-two patients with acute attacks of TPP over a 3-year-period were divided into 2 groups. Group A (n = 12) was a control group treated with normal saline infusion 125 mL/hr only. Group B (n = 20) received intravenous KCl administration at a rate of 10 mmol/hr in normal saline 125 mL/hr. During the attack and for 6 hours after muscle recovery, hemodynamics were continuously recorded and muscle strength and plasma K(+) concentration were measured hourly. The sex, age, muscle strength, thyroid function, biochemical values including plasma K(+) levels, as well as the time from attack to therapy (3.6 +/- 1.6 v 3.3 +/- 1.0 hr) were not significant between the 2 groups. However, recovery time was significantly shorter in the KCl group than the control (6.3 +/- 3.8 v 13.5 +/- 7.5 hr, P.01). Rebound hyperkalemia greater than 5.5 mmol/L occurred in 40% patients receiving KCl. The dose of KCl administered and peak K(+) concentration were positively correlated (r = 0.85, P.001). In conclusion, KCl therapy proves to help the recovery of paralysis in TPP associated with rebound hyperkalemia. KCl supplementation should be given as small as possible (10 mmol/hr) to avoid rebound hyperkalemia unless there are cardiopulmonary complications.

Hypokalemia with paralysis (HP) is a potentially reversible medical emergency. It is primarily the result of either hypokalemic periodic paralysis (HPP) caused by an enhanced shift of potassium (K(+)) into cells or non-HPP resulting from excessive K(+) loss. Failure to make a distinction between HPP and non-HPP could lead to improper management. The use of spot urine for K(+) excretion rate and evaluation of blood acid-base status could be clinically beneficial in the diagnosis and management. A very low rate of K(+) excretion coupled with the absence of a metabolic acid-base disorder suggests HPP, whereas a high rate of K(+) excretion accompanied by either metabolic alkalosis or metabolic acidosis favors non-HPP. The therapy of HPP requires only small doses of potassium chloride (KCl) to avoid rebound hyperkalemia. In contrast, higher doses of KCl should be administered to replete the large K(+) deficiency in non-HPP.

We report the case of a 57-year-old woman with the history of stage IB cervical cancer. She was found to have a metastatic squamous cell carcinoma in sigmoid colon. FDG PET/CT was then performed for whole-body cancer work-up. Intense FDG activity accumulated in the sigmoid tumor, with an unusually high SUVmax of 72.42, and was seen downwardly connected with the activity of urinary bladder on PET images. On the coregistered CT images, irregular wall thickening was noted for both sigmoid colon and urinary bladder with a hypodensity tract communicating with each other. It was concluded that recurrent cervical cancer involving urinary bladder and sigmoid colon resulted in colovesical fistula.

Objective.We retrospectively analyzed all primary aldosteronism (PA) patients undergoing NP-59 SPECT/CT imaging with regard to their clinicolaboratory and imaging features, investigation, and outcomes.Material and Methods.11 PA patients who presented to our hospital for NP-59 SPECT/CT imaging between April 2007 and March 2012 and managed here were analyzed.Results.Among 11 PA patients, eight (73%) had stage 1 hypertension, three (27%) stage 2 hypertension, four (36%) normal plasma aldosterone concentration, nine (82%) nonsuppressed plasma renin activity (PRA), six (55%) normal aldosterone-renin-ratio (ARR), eight (73%) serum potassium ≧3 mEq/L, seven (64%) subclinical presentation, seven (64%) negative confirmatory testing, and four (36%) inconclusive results on CT scan and seven (64%) on planar NP-59 scan. All 11 (100%) patients had positive results on NP-59 SPECT/CT scan. Two (18%) met typical triad and nine (82%) atypical triad. Among nine atypical PA patients, three (33%) had clinical presentation, six (67%) subclinical presentation, six (67%) negative confirmatory testing, and four (44%) inconclusive results on CT scan and six (67%) on planar NP-59 scan. All patients had improved outcomes. Significant differences between typical and atypical PA existed in PRA and ARR.Conclusions.NP-59 SPECT/CT may provide diagnostic potential in stage 1 hypertensive and atypical PA.

A 73-year-old man with a 10-year history of hypertension exhibited poorly controlled systolic blood pressure (BP), which remained at 190 mm Hg, despite treatment with six different classes of antihypertensives in the past 2 years. Laboratory analysis revealed potassium levels of 3.9 mmol/l, plasma aldosterone concentration (PAC) of 8.42 ng/dl (3.7–24.0 ng/dl), plasma renin activity (PRA) of 0.21 ng/ml/h (0.15–2.33 ng/ml/h), aldosterone-to-renin ratio (ARR) of 40.1 (>30), 24-h urinary vanillylmandelic acid levels of 1.67 mg (

Metastasis of colorectal adenocarcinoma to the larynx is a very rare condition. Here, we report a 72-year-old woman with a history of rectal adenocarcinoma. She was referred for whole-body FDG PET/CT scanning because of an elevating serum level of carcinoembryonic antigen. PET images showed focally increased FDG accumulation in the larynx (SUVmax=12.9). Coregistered CT images showed mild wall thickening at the left subglottic area. The findings of after excisional biopsy confirmed that this FDG-avid lesion was metastatic adenocarcinoma of the colorectal origin.

Primary aldosteronism (PA) may be missed in patients with chronic kidney disease (CKD), because CKD may disturb the renin-angiotensin-aldosterone system. Adrenal vein sampling has increased risks in patients with CKD. We report the case of a 58-year-old man with CKD and suspected PA. Left adrenal aldosteronism was diagnosed by NP-59 SPECT/CT. Left adrenalectomy demonstrated adrenocortical nodular hyperplasia. Plasma aldosterone normalized and blood pressure stabilized after surgery. NP-59 SPECT/CT may be a helpful diagnostic tool for detecting and lateralizing PA in CKD patients.

Measuring the plasma parathyroid hormone (PTH) concentration is crucial to evaluate renal bone disease in patients with renal failure. Although frequent measurement is needed to avoid inadequate prescription of phosphate binders and vitamin D preparations, artificial intelligence can repeatedly perform the forecasting tasks and may be a satisfactory substitute for laboratory tests. Neuro-fuzzy technology represents a promising forecasting application in clinical medicine. We therefore constructed a coactive neuro-fuzzy inference system (CANFIS) to predict plasma PTH concentrations in hemodialysis patients. The CANFIS was constructed with clinical parameters (patient age, plasma albumin, calcium, phosphorus, alkaline phosphatase, and calcium-phosphorus product) from a cohort of hemodialysis patients, and plasma PTH concentration measured by radioimmunoassay (RIA) was the supervised outcome. The accuracy of the CANFIS was prospectively compared with RIA in another hospital. Plasma PTH concentrations measured by RIA and predicted by CANFIS were 179.04 +/- 38.18 ng/l and 179.34 +/- 37.76 ng/l, respectively (p = 0.15). The CANFIS was able to precisely estimate plasma PTH concentrations in hemodialysis patients. These results suggest that the neuro-fuzzy technology, based on limited clinical parameters, is an excellent alternative to RIA for accurately predicting plasma PTH concentration in hemodialysis patients.

Hypokalemic paralysis is a less recognized but reversible disorder in elderly patients. This report describes two elderly Chinese males (age 74 and 78 years) who had progressive muscle weakness and eventually paralysis. Physical examination showed symmetrical flaccid paralysis of extremities. Both had the major biochemical abnormality of profound hypokalemia (1.4 and 1.8 mmol/L) accompanied by high urine K+ excretion and hyperchloremic metabolic acidosis. A positive urine anion gap and alkaline urine pointed to the diagnosis of distal renal tubular acidosis. Large doses of potassium chloride supplementation were required to restore muscle strength. Pertinent investigations, including elevated titers of antinuclear antibody and rheumatoid factor, positive anti-Ro antibody, low serum C3 and C4 levels, and delayed saliva excretion on salivary scintigraphy suggested Sjogren syndrome. Despite the lack of sicca syndrome at the initial presentation, both had development of typical sicca syndrome and positive Schirmer test at the 5-month and 1-year follow-up, respectively. Potassium citrate supplement and prednisolone therapy completely corrected the hypokalemia and metabolic acidosis. Extraglandular involvement with distal renal tubular acidosis preceding the typical sicca syndrome may induce hypokalemic paralysis and unveil Sjogren syndrome in elderly males.

A 31-year-old man underwent a whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) scan for cancer screening. There was no history of diabetes, thyroid disease, or noticeable exercise before imaging. The results demonstrated diffusely increased uptake of F-18 FDG in the thyroid and thymus. In addition, there was symmetrically increased uptake of F-18 FDG in skeletal muscles, especially in the psoas and limb muscles. The concurrent appearance of these characteristics led to a diagnosis of Graves' disease.

Background To investigate the role of upper extremity radionuclide venography as a potential diagnostic modality in the assessment of venous thrombosis associated with a Port-A catheter. Methods Fourteen symptomatic patients who had received Port-A catheter implantation were enrolled. A dynamic nuclear medicine flow study was performed with intravenous administration of Technetium-99m macroaggregated albumin to both upper extremities. Imaging patterns of the venous system were categorized as patency, partial obstruction, and total occlusion. Results The findings of the dynamic images clearly demonstrated clinical problems. Three patients were free of a definite venous flow change. Three patients had partial obstruction of venous return. A significant cut-off of venous return was demonstrated in 8 patients, and total occlusions were hence diagnosed. All patients underwent this procedure smoothly without any complication. Conclusion These results suggest that upper extremity radionuclide venography is an easily performed and effective method for diagnosing Port-A catheter thrombosis in clinical practice.

Objective Serum prostate specific antigen (PSA) concentration has been widely applied as a biomarker to diagnose and monitor prostate cancer. Technetium-99m methylene diphosphate (Tc-99m MDP) whole body bone scintigraphy is currently a well-accepted diagnostic procedure for bone metastasis in malignancy. The aim of this study was to establish a useful serum PSA cut-off value to predict the presence of bone metastasis in men with prostate cancer. Materials and Methods Consecutive male patients diagnosed with prostate cancer were retrospectively analyzed. All of the subjects had received both Tc-99m MDP whole body bone scintigraphy and had their serum PSA concentration measured within 1 month. The proper cut-off value was established based on statistical analysis in order to predict the possibility of bone metastasis among prostate cancer patients. Results In total, 101 consecutive male patients (age, 71.92 ± 0.76 years) with prostate cancer were enrolled, and 57 patients (56%) were confirmed by scintigraphic findings to have bone metastases. A serum PSA concentration of 13 ng/mL gave the best sensitivity (96.43%) and specificity (84.09%). The area under the receiver operating characteristics curve revealed excellent discriminatory power (0.93 ± 0.02; p = 0.001). The positive predictive value, negative predictive value and likelihood ratios for positive and negative test were 88.52%, 94.87%, 6.06 and 0.04, respectively. The resulting diagnostic accuracy and odds ratio were 73.87% and 142.76. Conclusion A cut-off value of 13 ng/mL appears to be an appropriate benchmark for stratifying metastatic bone disease in prostate cancer patients such that if a patient with newly diagnosed prostate cancer and without any skeletal symptoms has a serum PSA concentration of less than 13 ng/mL, we suggest that they would not need to undergo bone scintigraphy.